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Impact of HIV-1 status on the radiological presentation and clinical outcome of children with WHO defined community-acquired severe pneumonia
  1. P M Jeena1,
  2. A K Minkara2,
  3. P Corr3,
  4. F Bassa3,
  5. L M McNally1,
  6. H M Coovadia1,
  7. M Fox4,
  8. D H Hamer4,
  9. D Thea4
  1. 1
    Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
  2. 2
    Tufts University School of Medicine, Boston, MA, USA
  3. 3
    Department of Radiology, University of KwaZulu-Natal, Durban, South Africa
  4. 4
    Center for International Health and Development, Boston University School of Public Health, Boston, MA, USA
  1. Professor P M Jeena, Department of Paediatrics and Child Health, University of KwaZulu-Natal, Congella, Durban, South Africa; jeena{at}ukzn.ac.za

Abstract

Aims: We compared the radiological features and outcome of WHO defined severe pneumonia among HIV infected and exposed uninfected children randomised to receive penicillin or oral amoxicillin in Durban, South Africa.

Methods: Of 425 children aged between 3 and 59 months with WHO defined severe pneumonia, 366 had anonymous HIV testing performed. Outcome was assessed by failure to improve at 48 h after enrolment or deterioration within 14 days. Chest radiographs were evaluated according to WHO defined radiological criteria for pneumonia and internationally standardised radiological criteria. Findings were stratified for HIV status.

Results: 82 (22.4%) children were HIV infected, 40 (10.9%) were HIV exposed and 244 (66.7%) were HIV uninfected. The day 14 outcome in children <12 months of age was significantly worse in HIV-1 infected than HIV uninfected children (OR 2.8 (95% CI 1.35 to 3.5), p = 0.002), while HIV-1 infected and uninfected children aged ⩾12 months had equivalent outcomes. Parental penicillin and oral amoxicillin had equivalent response rates in all HIV groups. According to the WHO radiological classification, children who failed WHO standard antimicrobial treatment had significantly higher “other consolidates/infiltrates” than “endpoints for consolidation” in the HIV infected group (OR 5.45 (95% CI 1.58 to 21.38), p<0.002), while the reverse was true for HIV exposed uninfected children (OR 4.13 (95% CI 0.88 to 20.57), p<0.036).

Conclusions: The WHO standard treatment guideline for severe pneumonia is inadequate for HIV-1 infected infants. The increased prevalence of “other consolidates/infiltrates” among HIV-1 infected children who failed standard treatment supports the addition of co-trimoxazole to WHO standard treatment.

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Footnotes

  • Competing interests: None.

  • Abbreviations:
    ALRI
    acute lower respiratory infections
    DSMB
    data and safety monitoring board
    PCP
    Pneumocystis jiroveci (carinii) pneumonia

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